Severe fever and dyspnoea in a young girl with Hodgkin lymphoma
|
|
- Imogen Stevenson
- 6 years ago
- Views:
Transcription
1 Eleftheria Chaini 1, Dimitra Haini 2, Manos Antonakis 1, Miltos Vassiliou 3 elhaini@otenet.gr 1 Pulmonary Dept, Corfu General Hospital, Corfu, Greece. 2 Radiology Lab, Nikea-Piraeus General Hospital, Athens, Greece. 3 Medical School of Ioannina, Ioannina, Greece. Severe fever and dyspnoea in a young girl with Hodgkin lymphoma Case report Cite as: Chaini E, Haini D, Antonakis M, et al. Severe fever and dyspnoea in a young girl with Hodgkin lymphoma. Breathe 2017; 13: e10 e16. A 16-year-old girl was admitted to our department with fever and dyspnoea at rest. Symptoms had started 48 h earlier, without any beneficial effect of orally given cefuroxime tablets (500 mg every 12 h) during the last 2 days. A Hodgkin lymphoma was diagnosed 5 months before and the currently applied therapeutic schedule included bleomycin (accumulative dose of 90 units). The last applied regimen was given 10 days earlier. Propranolol (Inderal) was given orally for concomitant tachycardia episodes. The patient s clinical signs included pyrexia (39.5 C), tachypnoea (22 breaths min 1 ), hypoxaemia (pulse oximetry 92% on room air) and tachycardia (140 beats min 1 ). Blood pressure was 110/70 mmhg. Lung auscultation revealed decreased breath sounds at left lung base and fine bibasilar crackles, more prominent at the left side of the thorax. The rest of clinical examination was unremarkable. The patient underwent a chest radiograph (figure 1). Figure 1 Chest radiograph on admission day. Task 1 Describe the radiographical ERSpublications Differential diagnosis of a young Hodgkin lymphoma patient with severe fever and dyspnoea Breathe March 2017 Volume 13 No 1 e10
2 Answer 1 The chest radiograph showed patchy bibasilar consolidations worse on the left. Task 2 What is your differential diagnosis? e11 Breathe March 2017 Volume 13 No 1
3 Answer 2 Community-acquired pneumonia (CAP) and acute interstitial pneumonitis due to bleomycin-induced pulmonary toxicity. Two different diagnoses were considered for this case: CAP and acute interstitial pneumonitis due to bleomycin-induced pulmonary toxicity. Task 3 What investigation would be helpful? Breathe March 2017 Volume 13 No 1 e12
4 Answer 3 Blood tests, sputum and blood cultures, and urinary antigen tests for Pneumococcus and Legionella. a) L b) Pos -2.5 Pos Pos Pos Pos Pos Pos Pos The screening included usual blood tests, sputum and blood cultures, and urinary antigen tests for Pneumococcus and Legionella. The blood results showed a raised C-reactive protein (CRP) level (11.4 mg dl 1 ; normal range <0.5 mg dl 1 ), erythrocyte sedimentation rate (ESR) (106 mm h 1 ; normal range <30 mm h 1 ) and lactate dehydrogenase level (674 IU L 1 ; normal range IU L 1 ). The blood white cell count was normal (7520 cells μl 1 with neutrophils count 5960 cells μl 1 (79.3%)) as was the platelets count ( platelets μl 1 ). Lower than normal values were noted for haematocrit (28.2%) and haemoglobin (9.33 g dl 1 ). The blood tests for liver function, urea, creatinine, electrolytes, albumin and collagen disease were normal. Repeated blood cultures and urinary antigen tests for Pneumococcus and Legionella were negative. Echocardiography showed normal dimensions and contractility, normal tricuspid aortic valve and absence of pericardial fluid. The history of recent chemotherapy and the clinical signs suggested CAP as the first diagnostic choice. The patient was treated with intravenous antibiotics (moxifloxacine (Avelox) 400 mg once per day). In addition, trimethoprim/sulphamethoxazole (Septrin) 20 mg kg 1 day 1 was given in four equally divided doses, keeping in mind the probability of Pneumocystis jirovecii pneumonia in such an immunosuppressed patient. Oxygen was also delivered as supplementary. Despite the applied antibiotic therapy, the patient s clinical status deteriorated. Τhe hyperpyrexia continued. Dyspnoea and tachypnoea deteriorated (respiratory rate 40 breaths min 1, pulse oximetry 95% on 60% oxygen). Fast oxygen desaturation and talking difficulty was noted immediately after oxygen mask removal while platypnoea developed. Lung auscultation revealed dissemination of the crackles at all lung fields bilaterally. On the third day of hospitalisation, a new chest radiograph showed similar findings to the initial chest radiograph. These ameliorated imaging findings were in unexplained controversy with the severe hypoxaemia and the auscultatory data. The patient underwent chest computed tomography (CT) with intravenous contrast material (figure 2a and b). Pos Pos Figure 2 Chest CT on the third day of hospitalisation. a) Upper lung fields, b) middle and lower lung fields. Pos: position; W: window; L: level. Task 4 Describe the chest CT findings. e13 Breathe March 2017 Volume 13 No 1
5 Answer 4 Chest CT showed diffuse bilateral ground-glass opacities affecting all lung fields, mainly the middle and lower ones (figure 2b), and bibasilar paraspinal consolidations. No findings of pulmonary embolism were observed. Task 5 Based on the chest CT findings and the previous data, which is your diagnostic choice? Breathe March 2017 Volume 13 No 1 e14
6 Answer 5 Acute interstitial pneumonitis due to bleomycin-induced pulmonary toxicity. Based on the recent chest CT findings along with the clinical deterioration under antibiotics, the clinical signs of bibasilar crackles, the normal blood cell count and the recent chemotherapy with bleomycin, acute pneumonitis due to bleomycin-induced pulmonary toxicity became the first diagnostic choice. The patient was treated with intravenous prednisolone 1 mg kg 1 body weight with immediate dramatic improvement (remission of fever, decrease of dyspnoea and increase of oxygen saturation). The patient was discharged 7 days later without any symptoms and signs, with a respiratory rate of 18 breaths min 1, pulse oximetry 98% on room air, heart rate of 100 beats min 1, CRP of mg dl 1 and ESR of 29 mm h 1. On discharge, pulmonary function tests including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, single-breath diffusing capacity of the lung for carbon monoxide and transfer coefficient of the lung for carbon monoxide had values within normal predicted limits. Steroids were gradually tapered until stopping. 6 years later, the patient is in excellent condition. In accordance with all the aforementioned data, the final diagnosis is acute pneumonitis due to bleomycin-induced pulmonary toxicity. Discussion This is a case of a young girl with Hodgkin lymphoma who developed severe bleomycininduced pneumonitis (BIP) [1]. Bleomycin is an antitumour agent isolated in 1966 from Streptomyces verticillus bacteria [2]. Its cytotoxic action is exerted primarily through DNA cleavage, resulting in cancer cell death. This process is dependent on iron ions and molecular oxygen [2, 3]. The enzyme bleomycin hydrolase, a cytosolic aminopeptidase, inactivates the cytotoxic effect of bleomycin [3]. Bleomycin is used for the treatment of various types of malignancies, such as both Hodgkin and non-hodgkin lymphoma and germ cell tumours [2 4]. However, bleomycin chemotherapy has been associated with various toxicities, such as skin rashes, mucositis, hypersensitivity reactions and bleomycin pulmonary toxicity [5]. Pulmonary toxicity is the most important sideeffect during the therapeutic use of bleomycin. More specifically, the most common and severe pulmonary toxicity is BIP, which may progress to pulmonary fibrosis and is potentially lethal. Its incidence has been reported as >39.8% [6] and mortality ranges from 1% [7] to 2.8% [5] of the patients treated with bleomycin. BIP fibrosis has been described in 6 10% of cases receiving bleomycin [4]. The mechanism of BIP development is not fully clear. The low activity of bleomycin hydrolase enzyme in the lung is considered to be the main pathogenetic mechanism [3]. Οxidative damage, genetic susceptibility and release of inflammatory cytokines may play an additional role [2]. Additional risk factors have also been implicated in the development of BIP, such as older age (age >40 years), cumulative dose of bleomycin >300 IU, low glomerular filtration (<80 ml min 1 ), advanced disease (stage IV disease at the beginning of bleomycin administration) [7], inhalation of high doses of oxygen, cigarette smoking and radiotherapy [2]. The mechanism of BIP development in the current case is not clear. We could not identify any specific risk factors in our patient. Genetic susceptibility remains questionable. The disease is usually developed during treatment, as in the current case, but late presentation (several months after bleomycin chemotherapy) has also been reported [2, 4, 8]. BIP usually progresses gradually. In contrast, our patient developed acute rapidly progressive severe pneumonitis. The clinical presentation of the current case was not typical for BIP. Fever and dyspnoea, which were present in our patient, are usual symptoms of the disease, as are nonproductive cough and pleuritic pain [2, 4, 8, 9]. Crackles were discovered first and there were characteristic findings on chest auscultation that supported the diagnosis of development of BIP [6]. BIP presents a variety of imaging patterns on chest radiograph and chest CT, obviously dependent on the course and severity of the disease. The imaging findings of the current case, although not typical of BIP, contributed to the diagnosis of the disease. Radiographic manifestations may be absent in the early stages of the disease. They develop 1 2 weeks after the detection of crackles on chest ausultation [6]. Absence of radiographic manifestations in cases with severe pneumonitis has also been reported [9]. The typical radiographic findings of initial BIP stages are bilateral interstitial reticular or reticular micronodular lesions and alveolar infiltrates located mostly at the lower lung zones [6, 8]. These lesions may progress to consolidations [2, 8] and further pulmonary fibrosis [2] or to remit until complete disappearance after treatment with steroids [8]. Bilateral involvement of lower lung fields as in the present case is a more typical finding during BIP. Nevertheless, asymmetric radiographic findings with involvement of only one lung have also been described [9]. Chest CT has been reported to be more sensitive than a chest radiograph for evaluating the pattern and distribution of lesions [10], and the present BIP case is in agreement. Various imaging patterns have been described on highresolution CT in patients with BIP: small linear e15 Breathe March 2017 Volume 13 No 1
7 and nodular subpleural lesions identified primarily in the posterior segments [11], pulmonary fibrosis with or without consolidation [10, 12], organizing pneumonia [12], nonspecific interstitial pneumonia [12], ground-glass opacities [10], widespread bilateral consolidation [10] and bronchial wall thickening with areas of decreased attenuation [10]. The mixed chest CT pattern of bilateral diffuse ground-glass and organizing pneumonia in our patient supported the diagnosis of a rather advanced stage of BIP. The initial diagnosis of this case as CAP is a common diagnostic problem. BIP diagnosis is usually one of those remaining after exclusion of other possible diseases. Α history of bleomycin chemotherapy and compatible clinical and radiological findings suggest the diagnosis of BIP, while transbronchial biopsy is not helpful in the diagnosis [2, 4, 6]. Besides CAP, pulmonary metastases or lymphangitic carcinoma may also be included in the differential diagnosis [2, 4]. There are no proven effective treatments for BIP. Bleomycin cessation and administration of steroids at high doses (prednisolone 1 mg kg 1 body weight, tapering down) is the standard treatment of BIP in clinical practice [2, 4, 8, 9]. The complete recovery of the current case with steroids reconfirms the full reversibility of the lesions in patients with BIP surviving the acute episode [2, 4, 8]. Conclusions This is a case of a young girl with Hodgkin lymphoma who developed rapidly progressive BIP. The absence of risk factors demonstrates that the clinician should be suspicious of the development of pulmonary toxicity even in low-risk patients undergoing chemotherapy with bleomycin. Dyspnoea, cough, fever and crackles on chest auscultation are strong clinical signs of BIP development in patients under bleomycin treatment. Bilateral interstitial, alveolar and ground-glass opacities on high-resolution CT may help the diagnosis. CAP is the main feature in the differential diagnosis. Early recognition of BIP and initiation of steroid treatment is life saving and leads to full reversibility of the lesions. Conflict of interest None declared. References 1. Haini E, Georgopoulos A, Haini D, et al. Bleomycin-induced pneumonitis in a 16-year-old girl with Hodgkin lymphoma and no risk factors: complete reversibility with steroids. Chest 2016; 149: Suppl., A Sleijfer S. Bleomycin-induced pneumonitis. Chest 2001; 120: Sikic BI. Biochemical and cellular determinants of bleomycin cytotoxicity. Cancer Surv 1986; 5: Rashid RS. Bleomycin lung: a case report. BMJ Case Rep 2009 [ 5. Simpson AB, Paul J, Graham J, et al. Fatal bleomycin pulmonary toxicity in the west of Scotland : a review of patients with germ cell tumours. Br J Cancer 1998; 78: De Lena M, Guzzon A, Monfardini S, et al. Clinical, radiologic, and histopathologic studies on pulmonary toxicity induced by treatment with bleomycin (NSC ). Cancer Chemother Rep 1972; 56: O Sullivan JM, Huddart RA, Norman AR, et al. Predicting the risk of bleomycin lung toxicity in patients with germ-cell tumours. Ann Oncol 2003; 14: Stein ME, Zidan J, Charas T, et al. Bleomycin-induced pneumonitis in three patients treated with chemotherapy for primary advanced seminoma. J BUON 2015; 20: White DA, Stover DE. Severe bleomycin-induced pneumonitis. Clinical features and response to corticosteroids. Chest 1984; 86: Padley SP, Adler B, Hansell DM, et al. High-resolution computed tomography of drug-induced lung disease. Clin Radiol 1992; 46: Rimmer MJ, Dixon AK, Flower CD, et al. Bleomycin lung: computed tomographic observations. Br J Radiol 1985; 58: Usman M, Faruqui ZS, ud Din N, et al. Bleomycin induced pulmonary toxicity in patients with germ cell tumours. J Ayub Med Coll Abbottabad 2010; 22: Breathe March 2017 Volume 13 No 1 e16
Chest radiograph of an. asymptomatic man. Case report. Case history
Eleftheria Chaini 1, Niki Giannakou 2, Dimitra Haini 3, Anna Maria Athanassiadou 4, Angelos Tsipis 4, Nikolaos D. Hainis 5 elhaini@otenet.gr 1 Pulmonary Dept, Corfu General Hospital, Kontokali, Greece.
More informationNew respiratory symptoms and lung imaging findings in a woman with polymyositis
Maria Bolaki 1, Konstantinos Karagiannis 1, George Bertsias 2, Ioanna Mitrouska 1, Nikolaos Tzanakis 1, Katerina M. Antoniou 1 kantoniou@uoc.gr 1 Dept of Thoracic Medicine, Heraklion University Hospital,
More informationCommon things are common, but not always the answer
Kevin Conroy, Joe Mackenzie, Stephen Cowie kevin.conroy@nhs.net Respiratory Dept, Darlington Memorial Hospital, Darlington, UK. Common things are common, but not always the answer Case report Cite as:
More informationΑ 78-year-old female who presents with a non-resolving pneumonia: what is your diagnosis?
Evangelia Panagiotidou 1, Serafeim-Chrysovalantis Kotoulas 1, Maria Kilmpasani 2, Nikoleta Pastelli 2, Sofia Akritidou 1, Evangelos Chatzopoulos 1, Vasilis Bikos 1, Vasilios Bagalas 1, Katalin Fekete-Passa
More informationSESSION IV: MECHANISMS OF HUMAN DISEASE: LABORATORY SESSIONS PULMONARY PATHOLOGY I. December 5, 2012
SESSION IV: MECHANISMS OF HUMAN DISEASE: LABORATORY SESSIONS PULMONARY PATHOLOGY I December 5, 2012 FACULTY COPY GOAL: Describe the basic morphologic and pathophysiologic changes in various conditions
More informationDIAGNOSTIC NOTE TEMPLATE
DIAGNOSTIC NOTE TEMPLATE SOAP NOTE TEMPLATE WHEN CONSIDERING A DIAGNOSIS OF IDIOPATHIC PULMONARY FIBROSIS (IPF) CHIEF COMPLAINT HISTORY OF PRESENT ILLNESS Consider IPF as possible diagnosis if any of the
More informationDifferential diagnosis
Differential diagnosis Idiopathic pulmonary fibrosis (IPF) is part of a large family of idiopathic interstitial pneumonias (IIP), one of four subgroups of interstitial lung disease (ILD). Differential
More informationA Vietnamese woman with a 2-week history of cough
Delphine Natali 1, Hai Tran Pham 1, Hung Nguyen The 2 delphinenatali@gmail.com Case report A Vietnamese woman with a 2-week history of cough A 52-year-old nonsmoker Vietnamese woman without any past medical
More informationPULMONARY MEDICINE BOARD REVIEW. Financial Conflicts of Interest. Question #1: Question #1 (Cont.): None. Christopher H. Fanta, M.D.
PULMONARY MEDICINE BOARD REVIEW Christopher H. Fanta, M.D. Pulmonary and Critical Care Division Brigham and Women s Hospital Partners Asthma Center Harvard Medical School Financial Conflicts of Interest
More informationSystemic lupus erythematosus (SLE): Pleuropulmonary Manifestations
08/30/10 09/26/10 Systemic lupus erythematosus (SLE): Pleuropulmonary Manifestations Camila Downey S. Universidad de Chile, School of Medicine, Year VII Harvard University, School of Medicine Sept 17,
More informationINTERSTITIAL LUNG DISEASE. Radhika Reddy MD Pulmonary/Critical Care Long Beach VA Medical Center January 5, 2018
INTERSTITIAL LUNG DISEASE Radhika Reddy MD Pulmonary/Critical Care Long Beach VA Medical Center January 5, 2018 Interstitial Lung Disease Interstitial Lung Disease Prevalence by Diagnosis: Idiopathic Interstitial
More informationGuideline for the Management of Acute Chest Syndrome in Children with Sickle Cell Disease
Guideline for the Management of Acute Chest Syndrome in Children with Sickle Cell Disease Definition Acute chest syndrome (ACS) is defined as an acute illness characterized by fever and/or respiratory
More informationINTERSTITIAL LUNG DISEASE Dr. Zulqarnain Ashraf
Indep Rev Jul-Dec 2018;20(7-12) Dr. Zulqarnain Ashraf IR-653 Abstract: ILD is a group of diseases affect interstitium of the lung. Repeated insult to the lung cause the interstitium to be damaged. Similarly
More informationHRCT in Diffuse Interstitial Lung Disease Steps in High Resolution CT Diagnosis. Where are the lymphatics? Anatomic distribution
Steps in High Resolution CT Diagnosis Pattern of abnormality Distribution of disease Associated findings Clinical history Tomás Franquet MD What is the diagnosis? Hospital de Sant Pau. Barcelona Secondary
More informationA case of a patient with IPF treated with nintedanib. Prof. Kreuter and Prof. Heussel
A case of a patient with IPF treated with nintedanib Prof. Kreuter and Prof. Heussel Case Overview This case describes the history of a patient with IPF who, at the time of diagnosis, had symptoms typical
More informationImaging Cancer Treatment Complications in the Chest
Imaging Cancer Treatment Complications in the Chest Michelle S. Ginsberg, MD Objectives Imaging Cancer Treatment Complications in the Chest To understand the mechanisms of action of different classes of
More information4/17/2010 C ini n ca c l a Ev E a v l a ua u t a ion o n of o ILD U dat a e t e i n I LDs
Update in ILDs Diagnosis 101: Clinical Evaluation April 17, 2010 Jay H. Ryu, MD Mayo Clinic, Rochester MN Clinical Evaluation of ILD Outline General aspects of ILDs Classification of ILDs Clinical evaluation
More informationHYPERSENSITIVITY PNEUMONITIS
HYPERSENSITIVITY PNEUMONITIS A preventable fibrosis MOSAVIR ANSARIE MB., FCCP INTERSTITIAL LUNG DISEASES A heterogeneous group of non infectious, non malignant diffuse parenchymal disorders of the lower
More informationInternational consensus statement on idiopathic pulmonary fibrosis
Eur Respir J 2001; 17: 163 167 Printed in UK all rights reserved Copyright #ERS Journals Ltd 2001 European Respiratory Journal ISSN 0903-1936 PERSPECTIVE International consensus statement on idiopathic
More information11/19/2012. The spectrum of pulmonary diseases in HIV-infected persons is broad.
The spectrum of pulmonary diseases in HIV-infected persons is broad. HIV-associated Opportunistic infections Neoplasms Miscellaneous conditions Non HIV-associated Antiretroviral therapy (ART)-associated
More informationA 72-year-old male with worsening interstitial infiltrates and respiratory failure
A 72-year-old male with worsening interstitial infiltrates and respiratory failure Case report On November 24, 2004, a 72-year-old male was admitted to the medical intensive care unit (ICU) with a history
More informationTreatment of Coccidioidomycosis-associated Eosinophilic Pneumonia with Corticosteroids
Treatment of Coccidioidomycosis-associated Eosinophilic Pneumonia with Corticosteroids Joshua Malo, MD Yuval Raz, MD Linda Snyder, MD Kenneth Knox, MD University of Arizona Medical Center Department of
More informationPulmonary Pearls. Medical Pearls. Case 1: Case 1 (cont.): Case 1: What is the Most Likely Diagnosis? Case 1 (cont.):
Pulmonary Pearls Christopher H. Fanta, MD Pulmonary and Critical Care Division Brigham and Women s Hospital Partners Asthma Center Harvard Medical School Medical Pearls Definition: Medical fact that is
More informationAcute and Chronic Lung Disease
KATHOLIEKE UNIVERSITEIT LEUVEN Faculty of Medicine Acute and Chronic Lung Disease W De Wever, JA Verschakelen Department of Radiology, University Hospitals Leuven, Belgium Clinical utility of HRCT To detect
More informationFinancial disclosure COMMON DIAGNOSES IN HRCT. High Res Chest HRCT. HRCT Pre test. I have no financial relationships to disclose. Anatomy Nomenclature
Financial disclosure I have no financial relationships to disclose. Douglas Johnson D.O. Cardiothoracic Imaging Gaston Radiology COMMON DIAGNOSES IN HRCT High Res Chest Anatomy Nomenclature HRCT Sampling
More informationRadiation Pneumonitis Joseph Junewick, MD FACR
Radiation Pneumonitis Joseph Junewick, MD FACR 03/19/2010 History 16 year old with history of relapsed stage IV-A Hodgkin disease. Prior pulmonary involvement was irradiated. Diagnosis Radiation Pneumonitis
More informationBilateral Chest X-Ray Shadowing and Bilateral leg lesions - A case of Pulmonary Kaposi Sarcoma
Article ID: WMC005047 ISSN 2046-1690 Bilateral Chest X-Ray Shadowing and Bilateral leg lesions - A case of Pulmonary Kaposi Sarcoma Peer review status: No Corresponding Author: Dr. Mohammad Fawad Khattak,
More informationChronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease 07 Contributor Dr David Tan Hsien Yung Definition, Diagnosis and Risk Factors for (COPD) Differential Diagnoses Goals of Management Management of COPD THERAPY AT EACH
More informationAntimicrobial Stewardship in Community Acquired Pneumonia
Antimicrobial Stewardship in Community Acquired Pneumonia Medicine Review Course 2018 Dr Lee Tau Hong Consultant Department of Infectious Diseases National Centre for Infectious Diseases Scope 1. Diagnosis
More informationThe Management of Acute Chest Syndrome in Children with Sickle Cell Disease
The Management of Acute Chest Syndrome in Children with Sickle Cell Disease Document Information Version: 4 Date: Dec 2013 Authors (incl. job title): Professor David Rees and Dr Sue Height, consultant
More informationChanges in HRCT findings in patients with respiratory bronchiolitis-associated interstitial lung disease after smoking cessation
Eur Respir J 2007; 29: 453 461 DOI: 10.1183/09031936.00015506 CopyrightßERS Journals Ltd 2007 Changes in HRCT findings in patients with respiratory bronchiolitis-associated interstitial lung disease after
More informationMaking the Right Call With. Pneumonia. Community-acquired pneumonia (CAP) is a. Community-Acquired. What exactly is CAP?
Making the Right Call With Community-Acquired Pneumonia In this article: By Thomas J. Marrie, MD The case of Allyson Allyson, 32, presented to the emergency department with a 48-hour history of anorexia,
More informationEosinophils and effusion: a clinical conundrum
Ruth Sobala, Kevin Conroy, Hilary Tedd, Salem Elarbi kevin.peter.conroy@gmail.com Respiratory Dept, Queen Elizabeth Hospital, Gateshead, UK. Eosinophils and effusion: a clinical conundrum Case report A
More informationCombined Unclassifiable Interstitial Pneumonia and Emphysema: A Report of Two Cases
CASE REPORT Combined Unclassifiable Interstitial Pneumonia and Emphysema: A Report of Two Cases Nobuhiko Nagata 1, Kentaro Watanabe 2, Michihiro Yoshimi 3, Hiroshi Okabayashi 4, Katsuo Sueishi 5, Kentaro
More informationCryptogenic Organizing Pneumonia Diagnosis Approach Based on a Clinical-Radiologic-Pathologic Consensus
Cryptogenic Organizing Pneumonia Diagnosis Approach Based on a Clinical-Radiologic-Pathologic Consensus Poster No.: C-1622 Congress: ECR 2012 Type: Scientific Exhibit Authors: C. Cordero Lares, E. Zorita
More informationNitrofurantoin-Induced Lung Toxicity
Severe Nitrofurantoin-Induced Lung Toxicity Rami Jambeih, M.D. 1, John Flesher, M.D. 1,3, Joe J. Lin, M.D. 2,4 University of Kansas School of Medicine Wichita 1 Department of Internal Medicine 2 Department
More informationand localized ground glass opacities, or bronchiolar focal or multifocal micronodules;
E1 Chest CT scan and Pneumoniae_YE Claessens et al- Supplementary methods Level of CAP probability according to CT scan - definite CAP: systematic alveolar condensation, or alveolar condensation with peripheral
More informationOutline Definition of Terms: Lexicon. Traction Bronchiectasis
HRCT OF IDIOPATHIC INTERSTITIAL PNEUMONIAS Disclosures Genentech, Inc. Speakers Bureau Tadashi Allen, MD University of Minnesota Assistant Professor Diagnostic Radiology 10/29/2016 Outline Definition of
More informationJune 2013 Pulmonary Case of the Month: Diagnosis Makes a Difference. Lewis J. Wesselius, MD 1 Henry D. Tazelaar, MD 2
June 2013 Pulmonary Case of the Month: Diagnosis Makes a Difference Lewis J. Wesselius, MD 1 Henry D. Tazelaar, MD 2 Departments of Pulmonary Medicine 1 and Laboratory Medicine and Pathology 2 Mayo Clinic
More informationCommunity Acquired Pneumonia. Abdullah Alharbi, MD, FCCP
Community Acquired Pneumonia Abdullah Alharbi, MD, FCCP A 68 y/ male presented to the ED with SOB and productive coughing for 2 days. Reports poor oral intake since onset due to nausea and intermittent
More informationEastern Mediterranean Health Journal, Vol. 14, No. 5,
Eastern Mediterranean Health Journal, Vol. 14, No. 5, 2008 1217 Case report Inappropriate use of steroid and Pneumocystis jiroveci pneumonia: report of two cases P. Tabarsi, 1 M. Mirsaeidi, 1 M. Amiri,
More informationImmunocompromised patients. Immunocompromised patients. Immunocompromised patients
Value of CT in Early Pneumonia in Immunocompromised Patients Nantaka Kiranantawat, PSU Preventative Factors Phagocyts Cellular immunity Humoral immunity Predisposing Factors Infection, Stress, Poor nutrition,
More informationRadiological Imaging of Drug-Induced Pulmonary Lesions
Review Article imedpub Journals www.imedpub.com Journal of Clinical Radiology and Case Reports Radiological Imaging of Drug-Induced Pulmonary Lesions D souza M *, Rajiah P, Khan A and Irion K Department
More informationCase 1: Question. 1.1 What is the main pattern of this HRCT? 1. Intralobular line 2. Groundglass opacity 3. Perilymphatic nodule
HRCT WORK SHOP Case 1 Case 1: Question 1.1 What is the main pattern of this HRCT? 1. Intralobular line 2. Groundglass opacity 3. Perilymphatic nodule Case 1: Question 1.2 What is the diagnosis? 1. Hypersensitivity
More informationPatient with IPF and no honeycombing on HRCT. Case 1 Demosthenes Bouros, Vasilios Tzilas University of Athens
Patient with IPF and no honeycombing on HRCT Case 1 Demosthenes Bouros, Vasilios Tzilas University of Athens CASE OVERVIEW A 76-year-old male patient presented with progressive exertional dyspnoea refractory
More informationLung Injury after HCT
Lung Injury after HCT J. Douglas Rizzo, MD, MS Financial Disclosure None SCS06_1.ppt Background HCT an important therapeutic modality for malignant and non-malignant diseases Pulmonary Toxicity common
More informationImaging of cardio-pulmonary treatment related damage. Radiotheraphy and Lung
Imaging of cardio-pulmonary treatment related damage Dr. Andrea Borghesi Dr. Emanuele Gavazzi Department of Radiology 2 University of Brescia Radiotheraphy and Lung The goal of radiation therapy (RT) is
More informationTBLB is not recommended as the initial biopsy option in cases of suspected IPF and is unreliable in the diagnosis of rare lung disease (other than
TBLB is not recommended as the initial biopsy option in cases of suspected IPF and is unreliable in the diagnosis of rare lung disease (other than PAP) BAL is not required as a diagnostic tool in patients
More informationThoracic lung involvement in rheumatoid arthritis: Findings on HRCT
Thoracic lung involvement in rheumatoid arthritis: Findings on HRCT Poster No.: C-2488 Congress: ECR 2015 Type: Educational Exhibit Authors: R. E. Correa Soto, M. J. Martín Sánchez, J. M. Fernandez 1 1
More informationTreatment of rapidly progressive rheumatoid
British Journal of Industrial Medicine, 1973, 30, 396-401 Treatment of rapidly progressive rheumatoid pneu moconiosis DEWI DAVI ES Ransom Hospital, Mansfield, Nottinghamshire Davies, D. (1973). British
More information5/9/2015. Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective. No, I am not a pulmonologist! Radiology
Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective No, I am not a pulmonologist! Radiology Pathology Clinical 1 Everyone needs a CT Confidence in diagnosis Definitive HRCT +
More informationQuality Care Innovation lead clinician for integrated respiratory service georges ng* man kwong
Working in partnership Quality Care Innovation lead clinician for integrated respiratory service georges ng* man kwong chest physician pronounced ning qualified 1990 chief clinical information officer
More informationPATIENT CHARACTERISTICS AND PREOPERATIVE DATA (ecrf 1).
PATIENT CHARACTERISTICS AND PREOPERATIVE DATA (ecrf 1). 1 Inform Consent Date: / / dd / Mmm / yyyy 2 Patient identifier: Please enter the 6 digit Patient identification number from your site patient log
More informationIndex No. All five (05) questions should be answered. All questions carry equal marks.
POSTGRADUATE INSTITUTE OF MEDICINE UNIVERSITY OF COLOMBO POSTGRADUATE DIPLOMA IN TUBERCULOSIS & CHEST DISEASES EXAMINATION - MAY 2016 Date :- 4 th May 2016 PAPER I CASE HISTORIES Time :- 9.00 a.m. -11.00
More informationC.S. HAWORTH 1, A. WANNER 2, J. FROEHLICH 3, T. O'NEAL 3, A. DAVIS 4, I. GONDA 3, A. O'DONNELL 5
Inhaled Liposomal Ciprofloxacin in Patients With Non-Cystic Fibrosis Bronchiectasis and Chronic Pseudomonas aeruginosa: Results From Two Parallel Phase III Trials (ORBIT-3 and -4) C.S. HAWORTH 1, A. WANNER
More informationPneumonia. Dr. Rami M Adil Al-Hayali Assistant professor in medicine
Pneumonia Dr. Rami M Adil Al-Hayali Assistant professor in medicine Definition Pneumonia is an acute respiratory illness caused by an infection of the lung parenchyma, associated with recently developed
More informationARTICLE IN PRESS. Ahuva Grubstein a, Daniele Bendayan b, Ithak Schactman c, Maya Cohen a, David Shitrit b, Mordechai R. Kramer b,
Respiratory Medicine (2005) 99, 948 954 Concomitant upper-lobe bullous emphysema, lower-lobe interstitial fibrosis and pulmonary hypertension in heavy smokers: report of eight cases and review of the literature
More informationAll I Need Is The Air That I Breathe: A Case Study of Immunotherapy and Severe Pneumonitis
All I Need Is The Air That I Breathe: A Case Study of Immunotherapy and Severe Pneumonitis Presenter Disclosure Faculty/Speaker: Dr. Brett Finney BSc MD CCFP Relationships with financial sponsors: Grants/Research
More informationExacerbation of pre-existing interstitial lung disease after oxaliplatin therapy: A report of three cases
Respiratory Medicine (2008) 102, 273 279 Exacerbation of pre-existing interstitial lung disease after oxaliplatin therapy: A report of three cases Brad E. Wilcox, Jay H. Ryu, Sanjay Kalra Division of Pulmonary
More information11/10/2014. Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective. Radiology
Multi-disciplinary Approach to Diffuse Lung Disease: The Imager s Perspective Radiology Pathology Clinical 1 Role of HRCT Diagnosis Fibrosis vs. inflammation Next step in management Response to treatment
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Suntharalingam G, Perry MR, Ward S, et al. Cytokine storm in
More informationד"ר דוד ירדני המכון לגסטרואנטרולוגיה ומחלות כבד מרכז רפואי סורוקה
ד"ר דוד ירדני המכון לגסטרואנטרולוגיה ומחלות כבד מרכז רפואי סורוקה Presentation: S.A is 25 years old. Referred to a gastroentrologist because of abdominal pain and bloody diarrhea in the last few weeks.
More informationAnestesia Pediatrica e Neonatale, Vol. 10, N. 1, May-July 2012
Goodpasture s Syndrome in a 17 years girl. Fast track ICU support as bridge to full recovery after pulmonary failure. Daniela Codazzi 1, Antonio di Coste 2, Maria A. Scalera 1, Maria T. Ficarella 1 1 Division
More informationProfessor Rob Miller
BHIVA AUTUMN CONFERENCE 2013 Including CHIVA Parallel Sessions Professor Rob Miller University College London Medical School COMPETING INTEREST OF FINANCIAL VALUE > 1,000: Speaker Name Prof Rob Miller
More informationAbstract. Case Report. 中文題目 : 磁振照影顯影劑罕見副作用英文題目 : Acute Respiratory Distress Syndrome Following Gadolinium
中文題目 : 磁振照影顯影劑罕見副作用英文題目 : Acute Respiratory Distress Syndrome Following Gadolinium Administration 作者 : 陳寬展 黃嘉崙 吳世偉 蔡鎮良服務單位 : 三軍總醫院內科部 Abstract Gadolinium-based agent was applied in the contrast enhancement
More informationDifferential diagnosis
Differential diagnosis The onset of COPD is insidious. Pathological changes may begin years before symptoms appear. The major differential diagnosis is asthma, and in some cases, a clear distinction between
More informationGeneral History. 林陳 珠 Female 69 years old 住院期間 : ~ Chief Complaint : sudden loss of conscious 5 minutes in the morning.
General History 林陳 珠 Female 69 years old 住院期間 : 93.5.8~93.5.15 Chief Complaint : sudden loss of conscious for 2-52 5 minutes in the morning. General History DM under regular medical control for 10 years.
More informationLiebow and Carrington's original classification of IIP
Liebow and Carrington's original classification of IIP-- 1969 Eric J. Stern MD University of Washington UIP Usual interstitial pneumonia DIP Desquamative interstitial pneumonia BIP Bronchiolitis obliterans
More informationThe Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page
The Egyptian Journal of Hospital Medicine (July 2017) Vol.68 (2), Page 1135-1140 Role of High Resolution Computed Tomography in Diagnosis of Interstitial Lung Diseases in Patients with Collagen Diseases
More informationCase Presentations in ILD. Harold R. Collard, MD Department of Medicine University of California San Francisco
Case Presentations in ILD Harold R. Collard, MD Department of Medicine University of California San Francisco Outline Overview of diagnosis in ILD Definition/Classification High-resolution CT scan Multidisciplinary
More informationLife-threatening interstitial lung disease associated with trastuzumab: case report
Life-threatening interstitial lung disease associated with trastuzumab: case report M. J. Pepels, K. A. Boomars, R. Kimmenade, P. S. Hupperets To cite this version: M. J. Pepels, K. A. Boomars, R. Kimmenade,
More informationChronic Lung Disease in vertically HIV infected children. Dr B O Hare Senior Lecturer in Paediatrics and Child Health, COM, Blantyre
Chronic Lung Disease in vertically HIV infected children Dr B O Hare Senior Lecturer in Paediatrics and Child Health, COM, Blantyre Natural history of HIV in vertically infected children without and with
More informationA Case of Pediatric Plasma Cell Granuloma
August 2001 A Case of Pediatric Plasma Cell Granuloma Nii Tetteh, Harvard Medical School Year IV Our Patient 8 year old male with history of recurrent left lower lobe and lingular pneumonias since 1994.
More informationBeyond Conventional Therapy: Role of Pulse Steroids in Bleomycin Induced Lung Injury
1. Title of the manuscript Beyond Conventional Therapy: Role of Pulse Steroids in Bleomycin Induced Lung Injury 2. Authors a) First/Corresponding Author: Raghav Gupta, MD Internal Medicine, St Luke s Hospital,
More informationLung Allograft Dysfunction
Lung Allograft Dysfunction Carlos S. Restrepo M.D. Ameya Baxi M.D. Department of Radiology University of Texas Health San Antonio Disclaimer: We do not have any conflict of interest or financial gain to
More informationMiddle East Respiratory Syndrome-Coronavirus Infection: A Case Report of Serial Computed Tomographic Findings in a Young Male Patient
Case Report Thoracic Imaging http://dx.doi.org/10.3348/kjr.2016.17.1.166 pissn 1229-6929 eissn 2005-8330 Korean J Radiol 2016;17(1):166-170 Middle East Respiratory Syndrome-Coronavirus Infection: A Case
More informationNon-neoplastic Lung Disease II
Pathobasic Non-neoplastic Lung Disease II Spasenija Savic Prince Pathology Program Systematic approach to surgical lung biopsies with ILD Examples (chronic ILD): Idiopathic interstitial pneumonias: UIP,
More informationHypersensitivity Pneumonitis Common Diagnostic and Treatment Dilemmas
Hypersensitivity Pneumonitis Common Diagnostic and Treatment Dilemmas Rishi Raj MD Director, Interstitial Lung Diseases Program Clinical Professor of Pulmonary and Critical Care Medicine Stanford University
More informationGreen tea extract Its potential protective effect on bleomycin induced lung injuries in rats
Green tea extract Its potential protective effect on bleomycin induced lung injuries in rats Azza H. EL-Medany, Jamila EL-Medany The interest in the use of plant extracts in the treatment of several diseases
More informationUSEFULNESS OF HRCT IN DIAGNOSIS AND FOLLOW UP OF PULMONARY INVOLVEMENT IN SYSTEMIC SCLEROSIS
USEFULNESS OF HRCT IN DIAGNOSIS AND FOLLOW UP OF PULMONARY INVOLVEMENT IN SYSTEMIC SCLEROSIS Brestas P., Vergadis V., Emmanouil E., Malagari K. 2 nd Dept of Radiology, University of Athens, Greece ABSTRACT
More informationPulmonary And Central Nervous System Involvement In Juvenile Dermatomyositis: Vasculopathy And/Or Steroids As Causative Agents - A Case Report
ISPUB.COM The Internet Journal of Radiology Volume 4 Number 1 Pulmonary And Central Nervous System Involvement In Juvenile Dermatomyositis: Vasculopathy And/Or Steroids As Causative Agents - A Case Report
More informationSeptember 2014 Imaging Case of the Month. Michael B. Gotway, MD. Department of Radiology Mayo Clinic Arizona Scottsdale, AZ
September 2014 Imaging Case of the Month Michael B. Gotway, MD Department of Radiology Mayo Clinic Arizona Scottsdale, AZ Clinical History: A 57-year-old non-smoking woman presented to her physician as
More informationChronic lung diseases in children Simple choice 1. Finger clubbing is not characteristic for: a) Diffuse bronchiectasis b) Cystic fibrosis c)
Chronic lung diseases in children Simple choice 1. Finger clubbing is not characteristic for: a) Diffuse bronchiectasis b) Cystic fibrosis c) Bronchiolitis obliterans d) Complicated acute pneumonia e)
More informationA Case of Statin-Induced Interstitial Pneumonitis due to Rosuvastatin
CASE REPORT http://dx.doi.org/10.4046/trd.2015.78.3.281 ISSN: 1738-3536(Print)/2005-6184(Online) Tuberc Respir Dis 2015;78:281-285 A Case of Statin-Induced Interstitial Pneumonitis due to Rosuvastatin
More informationImaging: how to recognise idiopathic pulmonary fibrosis
REVIEW IDIOPATHIC PULMONARY FIBROSIS Imaging: how to recognise idiopathic pulmonary fibrosis Anand Devaraj Affiliations: Dept of Radiology, St George s Hospital, London, UK. Correspondence: Anand Devaraj,
More informationAvian Influenza Clinical Picture, Risk profile & Treatment
Avian Influenza Clinical Picture, Risk profile & Treatment Jantjie Taljaard Adult ID Unit Tygerberg Academic Hospital University of Stellenbosch jjt@sun.ac.za 083 419 1452 CLINICAL PICTURE The clinical
More informationSample Case Study. The patient was a 77-year-old female who arrived to the emergency room on
Sample Case Study The patient was a 77-year-old female who arrived to the emergency room on February 25 th with a chief complaint of shortness of breath and a deteriorating pulmonary status along with
More informationPULMONARY EMERGENCIES
EMERGENCIES I. Pneumonia A. Bacterial Pneumonia (most common cause of a focal infiltrate) 1. Epidemiology a. Accounts for up to 10% of hospital admissions in the U.S. b. Most pneumonias are the result
More informationHospital-acquired Pneumonia
Hospital-acquired Pneumonia Hospital-acquired pneumonia (HAP) Pneumonia that occurs at least 2 days after hospital admission. The second most common and the leading cause of death due to hospital-acquired
More informationProgression pattern of restrictive allograft syndrome after lung transplantation
http://www.jhltonline.org FEATURED ARTICLES Progression pattern of restrictive allograft syndrome after lung transplantation Masaaki Sato, MD, PhD, a,b David M. Hwang, MD, PhD, a Thomas K. Waddell, MD,
More informationESCMID Online Lecture Library. by author. CASE PRESENTATION ECCMID clinical grand round May Anat Stern, MD Rambam medical center Haifa, Israel
CASE PRESENTATION ECCMID clinical grand round May 2014 Anat Stern, MD Rambam medical center Haifa, Israel An 18 years old Female, from Ukraine, diagnosed with acute lymphoblastic leukemia (ALL) in 2003.
More informationMayo Clin Proc, May 2003, Vol 78 BCNU-Associated Pulmonary Fibrosis 631 Figure 1. Chest radiograph of BCNU-treated patient, showing small right apical
630 Case Report Upper Lobe Pulmonary Fibrosis Associated With High-Dose Chemotherapy Containing BCNU for Bone Marrow Transplantation JAMES M. PARISH, MD; JOHN R. MUHM, MD; AND KEVIN O. LESLIE, MD Upper
More informationClinico-Pathologic Conferences Early Bronchus-Associated Lymphoid Tissue Lymphoma Diagnosed with Immunoglobulin Heavy Chain Molecular Testing
Canadian Respiratory Journal Volume 2016, Article ID 7056035, 4 pages http://dx.doi.org/10.1155/2016/7056035 Clinico-Pathologic Conferences Early Bronchus-Associated Lymphoid Tissue Lymphoma Diagnosed
More informationA 31-year-old female with a rare cause of recurrent lower lobar collapses
Radhika Banka, Dayle Terrington, Ajay V. Kamath radhika.banka@gmail.com Dept of Respiratory Medicine, Norfolk and Norwich University Hospital, Norwich, UK. A 31-year-old female with a rare cause of recurrent
More informationACEM Fellowship Examination Emergency Medicine Practice Questions VAQ (Part C)
ACEM Fellowship Examination Emergency Medicine 2013-14 Practice Questions VAQ (Part C) Question 1 A 67- year- old lady presents to the Emergency Department (ED) with a history of increasing Shortness of
More informationAcute Respiratory Distress Syndrome (ARDS) An Update
Acute Respiratory Distress Syndrome (ARDS) An Update Prof. A.S.M. Areef Ahsan FCPS(Medicine) MD(Critical Care Medicine) MD ( Chest) Head, Dept. of Critical Care Medicine BIRDEM General Hospital INTRODUCTION
More informationClinical syndromes: experience from the bedside. Professor Rob Miller University College Hospital, London
Clinical syndromes: experience from the bedside Professor Rob Miller University College Hospital, London Presented at ECCMID Berlin April 30 th 2013 Pneumocystis jirovecii pneumonia http://commons.wikimedia.org/wiki/file
More informationBreathlessness in advanced disease. February 2017
Breathlessness in advanced disease February 2017 Breathlessness Managing breathlessness in primary care Chronic breathlessness Acute exacerbation of breathlessness Breathlessness at end of life Breathlessness
More informationInitial presentation of idiopathic pulmonary fibrosis as an acute exacerbation
Respiratory Medicine CME (2008) 1, 43 47 respiratory MEDICINE CME CASE REPORT Initial presentation of idiopathic pulmonary fibrosis as an acute exacerbation Krishna M. Sundar a,b,, Dixie L. Harris a a
More informationInvasive Pulmonary Aspergillosis in
Infection & Sepsis Symposium Porto, April 1-3, 2009 Invasive Pulmonary Aspergillosis in Non-Immunocompromised Patients Stijn BLOT, PhD General Internal Medicine & Infectious Diseases Ghent University Hospital,
More information